多灶性后循环缺血患者的病灶分布与血管形态异常及近期预后分析

Multiple infarcts in the posterior circulation： infarcts distribution, vascular malformation and prognosis

目的观察多灶性后循环缺血患者的病灶分布和血管形态异常的特点，评估患者出院时的近期预后及其与病灶分布和血管形态的关系。方法对34例经过MRI所证实的多灶性后循环缺血患者行主动脉弓及全脑血管DSA，全面分析病灶分布及血管形态异常的特点；同时对患者出院时的近期预后用改良Rankin分级（MRS）评分表进行评估，分析病灶分布及血管形态异常与近期预后的关系。结果多灶性后循环缺血患者最常被累及的部位是脑桥（22例），最常被累及的区段是中段＋远段（12例）；34例患者中有26例（76．5％）DSA显示出血管形态异常，最常被累及的动脉是椎动脉起始段（14例）和颅内段（13例）及基底动脉（7例）；出院时7例患者（20．6％）存在预后不良，其中6例（17．6％）为重度残疾，1例（2．9％）死亡。近中远段同时受累和基底动脉受累的患者表现出预后不良。结论血管形态异常是多灶性后循环缺血的重要病理基础和致病因素，病灶区段的分布和数目及血管受累部位是决定预后的关键因素。

Objective To analyze infarcts distribution and vascular malformation in patients with multiple infarcts in the posterior circulation and to investigate their correlation with the disease prognosis. Methods Thirty-four patients who had more than one infarct in the posterior circulation as shown on MRI were enrolled in the study. The digital subtraction angiography （DSA） of aortic arch and whole brain were performed on all patients and the images were analyzed and re-evaluated by two senior clinicians respectively. All the patients were assessed using Modified Rankin Scale （MRS） at discharge and correlation of infarcts distribution and vascular malformation with prognosis was evaluated. Results Infarct lesions most often involved pons （22 patients ） and the middle （pons and anterior inferior cerebellum ） plus distal territories （rostral brainstem, superior cerebellum and occipital and temporal lobes, 12 patients）. Vascular abnormality was found in 76.5% （26/34） of the patients. The common vascular lesions involved vertebral artery （ 14 patients ） , intracranial vertebral artery （ 13 patients ） and basilar artery （ 7 patients ）. The incidence of poor prognosis was 20.6% with 17.6% the severe disability rate and 2.9% the mortality rate. Patients with multiple lesions in proximal, middle and distal territories or basilar artery were likely to have poor prognosis. Conclusion Vascular abnormality is the main etiological factor for multiple infarcts in the posterior circulation. Infarcts distribution and the location of vascular lesions were key factors in predicting prognosis.